teachers felt during the passing of no child left behind. in desperate kinds of pressures on the nurses come to the of charting an extra discharge instructions, paperwork we have to do is really where the hospitals put the pressure and we are already spread so thin. so i just kind of wanted to get your opinion and if you could expand a little more on the decision behind that analogic rehiring not because it seems a little backwards. ..

that is what we need to study. it may go too far. cutting reimbursement hurts patient health. what we know for shore, and the closest parallel, in 1983 medicare went to a new reimbursement system. it is a new system where you need regardless what you did to the patient. after that, it retreated in the hospital.

almost 20% overnight. no reduction were no less healthy as a result. we retreated too excessively. we have to try to work and get that cut out. that cut out. >> we talk recently about the challenges in the supreme court, not in the individual mandate or the challenge out of florida. the federal government me uld force the state to raise the number of people who were me vered by medicaid and even though this was rejected at a lower leveuathe suupeme court reached out and decided they wanted to hear it again. what the chances none ut o this matters. the supreme court is just going to pull a citizens united and get rid of the law. >> the supreme couupe drejision his four elements.

one is a mandate. another is a much scarier one wone-c is the question of whethr the government can compel states 1 o government is paying for. the federal goveroveent reimburses 100% oofmedicaid coverage for the first several years and 90% after s1 oeral e foars. if the federal government can comf pl states toizndertake cotivities in the public good, and broad implication for many upograms forid arge part ut o h we do the social insurance in 1 o i wis very distressed to see this. only one decisuprn supported 1 o was the most radical of all the

paul cleve bryan to compare the costs of how massachusetts made the transparency in the market for insurance. i am a practicing physician and one thing, lack of transparency and understanding, for that matter, the outcomes, i am unclear, short of the acl model, to providers of health care, to understand the consequences that can make better decisions. >> the bill does not do enough explicitly. it does things implausibly. new structures where insurers

back to physician the. a great example of the feedback would be discussions about end life care. sarah palin does the death panel then we are done. a lot of explicit language about physician information, got labeled as rationing and pulled from the bill. the hope is implicitly this will happen. the fact that insurers will subways to reimburse care and bring physician interests and having that information. pc organization set up, and primary care physicians will see the cost of the specialists recommending things that bear financial risk. and going through the pocket if you send specialists. we're giving you something if

you send them something less expensive. given the government is politically unable to set those up, to lead on that front. >> there's a fair amount of us who are residents and in training we hear a lot about you need to wear this test to cover yourself or document this or cover yourself. is there anything in the bill that will have some changes in medical to change your reasoning a little bit more about when you are ordering so that it is not always covering yourself. >> i never talked to crowds that include doctors were asked about malpractice. i was getting worried. according to doctors groups are talk to, 100% of our health

care, in all seriousness it is a tough problem. malpractice is a trivial part. and premiums is 3% health care spending. it could be caused by people worried about malpractice regulation. we just don't know. the best evidence is from a harvard kennedy school. he estimates it is about 3% of health-care spending due to malpractice but the truth is people that out of the hat. we don't really know how much is defensive medicine. what the bill does is include the ability of state to set up pine nuts. remedial panels on the legal system. some states try to tap the damages. our relatives killed by a

doctor, a damaged cap is not the right answer. we need to move toward a rational system where case are handled in a way that the compensation is done. it is not a big a problem as doctors think. when medical malpractice doctors worry about doing the right thing and doing things like that. see if that can help. >> there have been some editorials in the medical community about the success of medicine that more and more people living to old age and we will actually have more dementia, worldwide incidents increasing and with end life

care, and support ideas for helping with managing those costs. >> it is a growing share of the health care bill. it is an important issue, to introduce insurance principal. decided it was not written appropriately and the administration is not implementing that. there are other features in the bill, community-based care which is cheaper and make it happier. and to be honest that is something we need to keep working on by ever rising costs, as the population ages and end

of life care. >> i want to ask about a potential access issue with many previously uninsured folks in the fold of health care. with primary care, primary-care physicians and if we're going to have sixty million people, and how are we going to have that? >> in massachusetts, we had a shortage of primary-care physicians and it hasn't changed. thirty-two million people at the insurance roll. you can add that many people without putting strain on the system which is already constrained. that is why features improve primary care -- number of primary care physicians. it is not enough. go to med school right now. here is your choice. you could be a community dr..

you could make $150,000 a year. good living working 60 hours a week. or you can be dermatologist and make $400,000 a year of work 40 hours a week. what are kids supposed to do? basically we have a system that is out of whack with fundamental reimbursement that we are putting in place for different types of doctors and until we get that in place we are not really going to deal with the primary care shortage in america. >> stage right. >> i want to ask about basic health and hope you will make an argument. you have written something about everything that goes from 130% of poverty to 200%. it is not really helping that much. it will be hard to pay the premium because it is too high. also the problem of reconciliation. and members will be mad when they find out i talked them into

buying health care. william a case? i will not make the case to others and argue we should have the health plan -- basic health plan. >> someone has read my work. thank you. the basic health plan. flexibility in this bill. the way the bill works is ban medicaid to 130% of the poverty line. the fix idea is $30,000 for a family and above that level until we get to four times the poverty line or $80,000 for a family there is tax credit to buy private health insurance where you buy a certain percentage of income on a sliding scale and the government picks up the rest of the cost of insurance. from 133 to 200% is $45,000 a

year for family. will for that because we pay less than the public insurance program. we have people pay less and paid doctors less. imagine doctors are not a huge fan of this option necessarily. there are arguments for and against it. it makes insurance more affordable for remaining low-income population. the argument against it is in my view it doesn't keep insurance turning and puts a lot -- we have a question about primary-care doctors. they are already strained to see the publicly insured population reimbursed so little and put more strain on that. it is a decision each state needs to look. the basic health plan is based on a plan in washington state which was the genesis of the basic health plan. some states like washington state want to keep that. other states which haven't had a system like that will have to consider it. i don't think there's a right answer. it is a state-by-state basis. >> exit stage left.

shifting back to politics, one way mitt romney did in massachusetts, worked in massachusetts but would not necessarily be the right thing for the nation. from an economic perspective any particular reason the massachusetts approach would not scale nationwide? >> no. [laughter and applause] >> basically mitt romney had a choice. he had a choice of three things he could have done. he could have done what newt gingrich did and this about it and said i made a mistake. it is in the paths. he could have said was the right thing to do and a great idea. he tried the middle ground of saying the massachusetts, not for everyone else. he sort of told a couple of disingenuous things. that is why it is a good idea. raise taxes because the fed pays

for bail. it is cheaper to argue that. then he said it is not right for the rest of the country. i may not work for the rest of the country. it does work for the rest of the country. >> last question stage right. >> we estimate there are probably a thousand people who are homeless, some for reasons of their own, refused to apply for medicaid. what will happen to these people who refuse to get access to health insurance? >> i am a big fan of the affordable care act and i am glad for olive did but it doesn't do everything. remaining problem remains. low income people on the margins of society.

in massachusetts we achieve 90% insurance rate. ninety% are insured. the 2% are unsure are mostly people who get free health insurance and they don't take it and these are people in the margins of society and does comprehend the language barrier. a huge role for community outreach to continue to explain to people the system is there for them and the system can help them so much more as they wait until they are sick. as we talk about -- this bill does not solve all the problems. we need help from community organizations to make sure people get into the system. >> i would like to thank the audience. this is the most knowledgeable and enjoyable audience. great questions. one quick comment to make. we got public education 20 years ago and we have been fighting

about it ever since. we do the same thing with health care. all the questions here we are pointing out, it is a structure. we made some decisions to the country and i would like to see us making it better. i would like to thank john. [applause] >> thank you. thank you very much. thank you for having me. [inaudible conversations] >> is there nonfiction operable to like to see feature on booktv? send us an e-mail at

booktv@c-span.org. >> up next author sally pipes argues against president obama's health care initiative and present her own plan to restructure the american health-care system. this is an hour and 15 minutes. >> good afternoon and welcome to the heritage foundation and the lewis lerman auditorium. we welcome everyone who joins us on our heritage.org web site on all these occasions and would ask everyone in house if you will make the last courtesy check, we begin a program. we will post this event within 24 hours on our web site for everyone's future reference as well. hosting our discussion today is nina owcharenko who is director of health policy studies and also it past recipient of heritage's rita ricardo campbell

award for her outstanding contribution to the analysis and promotion of a free society particularly in her work on the s shipped debates. before joining heritage she served on capitol hill working on the house side for then representative jim demand and su wiring and also worked in the senate earlier than that working for senator jesse helms. please join me in welcoming nina owcharenko. [applause] >> thank you and thanks to all of you for being at our event today. tuesday night president obama barely mentioned his landmark legislative victory, patient protection and affordable care act and no wonder. americans continue to dislike the health care law more than they like. every day there's a new glitch or contradiction that surfaces raising more doubt that this elaborate plan can actually work. further complicating matters for the administration is the decision by the supreme court to

consider the law's constitutionality. we wait to see the case unravel in coming months it is still critically important that americans are reminded that unless the supreme court strikes down the law in its entirety, there's plenty to be concerned about. we will hear from a distinguished panel of health care experts will discuss why full repeal must remain a top priority and help provide an alternative vision for what a responsible health care reform proposal would look like. let me take a few minutes to introduce them to you. first, sally pipes, president and ceo of the pacific research institute and author of two notebooks we have out front on the health care law. the truth about obamacare published in 2010 and her newest book the sally pipes plant:the top ten wasted dismantle obamacare. second we will hear from michael

tanner. he penned an excellent review of the health care law in "bad medicine: a guide to the real costs and consequences of the health care law". which has been newly updated and revised. last but not least we will hear from grace-marie turner, president of the game in institute. following enactment of the health care law grace-marie turner along with jim carpenter with ethics and policy center, tom miller at the american enterprise institute and art trudy bob moss that of the heritage foundation joined together to publish the book "why obamacare is wrong for america". please help me in welcoming them to heritage today. [applause] >> we will start with our. sally. >> thank you. i am delighted to be here with my friends michael tanner and grace-marie turner as well. with the historic vote the 2700

page patient protection and affordable care act was passed into law on march 23rd, 2010. how fast two years have gone. almost the second anniversary. as nina mentioned it was interesting to me the state of the union on tuesday evenings the president devoted only 44 words to health-care reform. i think it has to do with the fact as nina said that will leave 53% of americans support repeal of this legislation. i wrote my first book the truth about obamacare when nancy pelosi said we have to pass this law to find out what is in it i thought i could write something in 257 to say what is in it. she has read my book. my new book the pipes plan legal the top-10 ways to dismantle and replace obamacare, deals with people who criticize the people who support repeal. you don't like the law but what

is your plan. i thought i would do a ten point plan being big staffers ways for repeal and replacing it. had a positive agenda. i would like to say understanding health care is similar to unraveling an onion. there are many layers and many careful moments. we all want to find affordable, accessible, quality care for all americans. that is our goal. how do we achieve that goal? there are two visions. one which focuses on empowering the patients. the other focuses on increasing the role of government in health care to increase taxes, mandates, subsidies and controls on insurance companies. obama gave 58 speeches on health care before it was passed and started talking earlier about health care reform but switched in august of 2009 to talk about

health insurance reform. the president ultimately wants and medicare for all. to want to single payer canadian-style health care system which i grew up in in canada. how do we achieve universal coverage and the cost curve down? in 2010 spent 17.9% gross domestic product on health care. that is a lot but we demand the best. americans are impatient. they want everything right now. canada. will the country i am from sends 2.4% dungee vp of global budget is set by government. canadians demand much more on health care so you get a long waiting lists and the frazier institute where i worked until 1991 we started a publication called waiting your turn:a guide to hospital waiting lists in canada. last year the average wage in canada from seeing a primary-care doctor to getting treatment by a specialist was 19

weeks. that is almost five month and the longest time since the reporting of wait times. is very important that obamacare be repealed and replaced with an agenda that brings about affordable, accessible quality care. the other point is doctors, in number of doctors are going to get out of the practice of medicine unless this law is repealed. 90% of doctors are upset about obamacare but will impact negatively on how they practice medicine. the other key point is that study shows people -- 69% of doctors feel the best and brightest are not going to go outside medicine. that is discouraging for the future of our health. in my book the truth about obamacare i talk about a number of colors. 14 of them. i will talk about replacement

issues. the president wanted universal coverage to send the cost curve down. those two main goals. we are not going to achieve universal coverage the cbo says by 2019. twenty-three million americans will still be running short. we will add 16 to eighteen million people to medicaid. when i look at the uninsured number, 58.2 million americans, seventeen million are eligible for medicaid s. cit and haven't signed up. i believe it is because doctors get low reimbursement rates and lower medicaid patients and they get care. on getting the cost curve down the bill costs $900 billion, and the cbo says today it is $1.5 trillion and i believe, in 2014 to 2024, the cost of this

legislation, $2.4 trillion, may be more. the adding of 16,002 irs agents. the ending of discrimination. those will be cost drivers and obama was politically astute in bringing down the cost drivers after the 2012 election. the individual mandate is a very bad idea. the game in institute, benjamin rush society and officer patient care, we are filing a brief in the supreme court case on the individual mandate and its impact on uncompensated care and what that will do to the cost of

care. the issue of severeability. can states before us to act? all these eighteen million people. medicaid and the anti injunction act. if this is a tax which i believe it is how can the court -- can the government start counting a tax before it is introduced in 2014? they won't be able to see the impact of the tax until 2015 when people file tax returns. it is an important issue to the individual mandate and the and constitutionality versus constitutionality. the real problem is if the court rules this mandate is constitutional, this will be the first time the federal government will have the power to tell us not only that we have to buy health insurance in the private market but what will be the limit of that power? will we have to buy the prius car? what will we be told we have to

live on broccoli and have meet? and a key to obamacare. many economists believe if this legislation is not repealed and replaced and the president really wants the single payer system. private insurers are going to be crowded out of the market. ultimately there will be a public option. there's already talk about it. private insurers will not be able to complete -- grace marie show that private insurers are out of the market in insurance. so then we will all be left in a single payer system where care is rationed. we face long waiting lists and lots of access to the latest technology and treatment. where will the best doctors the? where will we as patients go? canadians have an escape valve but where are we going to go? i believe the president, nancy pelosi and harry reid have an ideological vision that government should be making decisions for us rather than

ourselves making individual about how our lives are to be built and it is a very frightening scenario. on repeal a few things could be done right now. the 2.3% tax on medical devices that comes into effect should be repealed. the independent advisory board should be repealed. number of democrats don't like it as well. that is a very important part because that will control a lot of our seniors receive their health care under medicare. and repeal of the class act. kathleen's of delius said we cannot make the -- kathleen sibelius said we cannot make it work so they're not moving forward. the house will introduce a bill next week to repeal the class act and it is very important that it is repealed. i don't know if the senate will vote to repeal or whether the senate will be so -- if the president signed the bill to end the 1099 reporting requirement but i hope the class act can be repealed.

how do we achieve universal coverage? i talk about these are the solutions in my book. i believe in 2012 we need a new congress, in new president. in 2013 congress can refill the patient protection and affordable care act and replace it with an agenda and things that i believe in. what is the replace agenda? we need to empower doctors and patients. we need to support health savings accounts. that is one of the first. we need to change the federal tax code. the government got us into this mess in world war ii when price controls were in. 60% of americans get their health care through their employer. we get it with pretax dollars. if we have health insurance with after tax dollars. we would like to see them early on. and individuals could get their health insurance with pretax dollars. people should be able to buy their health insurance across

state lines. why should a young man in new york, stay with guaranteed issue community ratings have to spend $5,000 a month on health insurance when he is young and invincible. he should be able to buy health insurance plan that suits his individual needs. we need to get states to reduce state mandate. there are 2100 across the country. they add 50% of the cost of insurance. if i want to buy health insurance plan with in vitro fertilization i should be able to get it. why should my -- why should michael tanner buy insurance plans of the rise was i went? if nina wants the health care plan that covers alcohol rehabilitation to allow her to survive, all of this work on obamacare she should get it but i don't want to subsidize her. getting states to reduce those mandates. medical malpractice reform. i believe this should be a state issue. not a federal issue.

the cost of medical malpractice and defensive medicine is $210 billion a year according to price waterhouse coopers. 16,000 doctors have gone to texas. in may of last year rick perry the governor of texas signed a lot that loser paid which is very important. the president said over and over again doctors, do too many tests. they want to line their pockets with money. doctors practice defensive medicine for the same reason they are afraid of being sued. for we want to expand access to health savings accounts. i believe the president doesn't like savings accounts. he does not want people to be in charge of their health care but that is where we're seeing reductions in premiums and particularly for younger people. that is the way to go. we need to they regulate state based exchanges. a number of states returned the

money. a number got waivers. california was the first stage to take the money because everything liberal happens in california. we need to support h a s as. we don't need government controlled state based exchanges telling insurers what is going to be an essentials benefit plan. we need to do medicare reform. we do not continue entitlement programs. and medicare, medicaid and social security as they have been going on. medicare will be bankrupt by 2020 for if we don't make changes. when it was set up in 1965 the average person lived to age 65. today they live to age 80. we need to raise the eligibility age. we need to means that it. why should a person like warren buffett and pays less tax than his secretary, why should someone like warren buffett be on a government run program? medicare should be there for the

people who really needed. they will do premium support in medicare. and we can control costs. nancy pelosi said over and over again if we do premium support on these things all of our seniors will be dying in the streets. seniors will be dying in the streets unless we make changes to these entitlement programs. medicaid, we need to change to medicaid. we need to do what grants and this is an important part of the supreme court case on power of the federal government to force states to expand medicaid programs. hmo bureaucrat, government bureaucrat or you yourself. danny williams, former premier of newfoundland, said i went to the state of miami to mount sinai hospital staff my heart surgery done because i couldn't

get it in newfoundland. a long wait in ontario. he went to mount sinai and paid out of pocket and had surgery done. when he came back the canadian media was furious because this was their signature issue. single payer health care. danny williams said i had it done because it is my health, my heart and my choice. universal choice is the key to universal coverage. we are on the road to serfdom unless this legislation is repealed and replaced. repeal and replace are the only solutions and as our dear friend p.j. o'rourke says if you think health care is expensive now just wait until it is free. thank you. [applause] >> thank you to the heritage foundation for having me here. for those who are stuck inside

the beltway, i am sorry. but second you well know the heritage foundation and cato institute don't always see eye to eye when it comes to health care. grace mary often has to block a senate rule until we come to terms. one thing we agree on is the patient protection act is an absolute disaster and needs to be repealed in its entirety. i want -- that is the cost because even though the president only devoted 189 words of his state of the union address to the question of deficits and debt. i believe that is truly the overriding issue of our time. after all we are still borrowing $0.34 of every dollar that this country spends. we have a $15 trillion on the

books that at this point and include the unfunded liabilities of social security and medicare are total indebtedness that exceeds $120 trillion. in that context the cost of obamacare becomes crucial. there was that great moment before obamacare passed, harry reid and nancy pelosi and the rest of the democratic leadership cannot of the steps of the capital and were just locating the shoulders because they're patting themselves on the back so hard because they said they had gotten the cost of the patient protection act down to $940 billion. shows how long it has been, and a lot of money. the problem is the ink was dry

on the bill before that nine forty billion number began to unravel. it seems for example they may have left out a few things. for example there is the actual cost of implementing the bill with the congressional budget office estimating $115 billion. that was the cost of everything from hiring new irs agents that have to enforce the individual mandates to hiring people to oversee the exchanges to the new insurance regulators. all of this is going to have cost. this is authorized but not appropriated funds and doesn't have to be counted as cost of the bill because it is not being spent yet. it will be in the future but don't actually count it just yet. then of course there is some slight of hand whereby they assumed that medicare would be cut by 23% in order to help fund

this. the notorious doc fixed idea. in fairness i have to say that cut was in current law. had been since 2001 and every year congress looked at this and not being particularly suicidal they postponed that cut but to get the cost down to $940 billion it was assumed in 2010 for the very first time that cut would take place. not to assume anyone in washington is cynical, but at the same time they were assuming 26% cut would take place there reintroducing a separate bill to repeal the 23% cut. when asked about that they said that as a separate bill. it costs $350 billion but that is over here. that is not part of our bill.

just think how much better your household budget would look if you could say your mortgage is a whole different cost and didn't have to count it. the usual postponement of its, has already been postponed twice. if you have been watching the dust off over the bill to cut the payroll tax, you can scratch that $350 billion savings as well. there was double counting that went on, famous washington bookkeeping ways, it reduces medicare spending by $500 billion going forward and this was in addition to the 23% cut and $500 billion they think they will save by introducing efficiencies by wiping out the medicare advantage program and doing things of that nature they pay $500 billion. they use that $500 billion to, quote, extend the light of the

medicare trust fund and simultaneously the same $500 billion fund the cost of subsidies under obamacare. even in washington spending the same dollar twice has this problem. maybe you can't double count that but they double count social security taxes which will pay social security benefits and fund under obamacare. there are a number of these gimmicks that are built in. if you take all of these costs you find the real cost of this bill is a for the $2.7 trillion, $800 billion to the federal deficit over the first ten years of operation. that understates the problem because since then we learned other things. they included $50 billion of revenue that came from the class act which is a giant ponzi scheme, and paid it out beyond the ten year budget window so they could count the revenue but

didn't have to count the payout. since it turns out the class act is not going to take place, it is not going to be implemented, can't count that $50 billion anymore, you have that $50 billion in costs and finally there's the cost of subsidies under the exchanges. when the bill was passed they estimated nine million americans would be put into these health-care exchanges in the state, estimates are in excess of twenty million americans will go in and that underestimated because there will be an incentive on behalf of business to dump their employees into the exchanges where it is cheaper because they are out for the penalty of a $3,000 penalty for not ensuring someone versus $7,000 for paying for their insurance, $10,000 paying for their insurance but the federal government will subsidize them and you don't have to pay for it as a business and you are much better off simply paying the penalty and getting your workers out and then you don't have the

hassle of having people come to deal with your h.r. department because they don't like your insurance plan and you save the money. the more people get dumped into the exchanges the more subsidies the federal government will have to shell out. even if you say twenty million americans in there. the cost of this bill over and above $3 trillion or so that we are already talking about. we keep piling more and more costs into this bill. we are paying for it and have $680 billion in taxes. if you notice there's a shortfall. that is the problem we have been dealing with on behalf of the federal government. frankly you could have some up the entire state of the union address in two words. we are broke. we don't have a couple trillion dollars line around to pay for this very costly and wasteful

and dangerous program. if you leave aside the bad impact on health care we're going to hear about the increase of waiting times. all the other bad thing that will do, we need to repeal this as a matter of fiscal sanity. thank you all very much. [applause] >> good afternoon. thank you for hosting us today and thank you at heritage for hosting this. 2012 is the year of the cap. this is the year that is going to determine not only the future of health care in america but the future of our freedom. what can congress not commandeer us and the state to do on the basis of constitutional principles. either we are going to turn our

health sector into a centralized system. we are going to get to work fixing the very real problems that do exist in the house sector. putting in place policies that get the incentives right that put doctors and patients in charge of medical decisions and truly began to reform medicare and medicaid. medicaid which i truly believe is the worst health care program in america and yet one that by the time this what is up and running, eighty-seven million people in this program. that is not an acceptable outcome and it still leaves twenty-three million people uninsured. when the court makes its decision it could range from throwing out the old law to letting the law stands and some

probably much more likely complex range of decisions in between. the most optimistic and most realistic scenario is they declare the individual mandate unconstitutional and some narrow frame. that is my hope. wishful thinking. they leave the rest of the law standing which is going to be a big mess because people are really beginning to think that the president's legal occasional time to talk about this lot just mentioned a few things. 26-year-olds on current policies. a few insurance reform, preventive care, they don't understand the complexity of this law. he never for example of this chart. the joint economic committee did last year. trying to depict one third of

this health law. from one 59 bureaucrats and commissions. the american people are necessarily confused about this law. when the president, he and his secretary talk about this they just talk about these provisions. not about the whole law and what its sweeping impact is going to be and the president really when we heard in his speech last night only 44 words are devoted to health care. the administration is adopting a strategy of silence after spending two years almost bleak as the year and half getting this health care law passed. they stopped talking about it. not surprising because the law is hugely unpopular. the latest tracking poll from the kaiser family foundation shows that the law remains as unpopular as ever. a majority of americans continue

to oppose the law. overwhelming majorities -- most because they believe it is an over reach of government power but also because they think mandated insurance is too expensive but they know it will get more expensive and they are right when the government is mandated what has to be in that policy. the individual mandate is short because of the upcoming supreme court argument but another poll that i thought was interesting, a majority, 55% believe parts of the law would be implemented if the court strikes down the individual mandate and freehand can make a ruling against it effectively will mean the end of the entire law. that feeds into the president's

to do things. the preexisting condition pools, free preventive care, eventually filling the doughnut hole in the prescription drug benefit. after the 2010 election, a referendum on obamacare the president was pretty belligerent in saying people -- it wasn't about obamacare. i just didn't explain it well enough. and insisted that the law only needed a bit of, quote, tweaking. i think his democratic political advisers eventually got to him and they and his white house advisers reached a really inescapable conclusion and i thought was best put by democratic pollster had todel deuce said the economy as

important as it was was not the decisive factor in this election. american people found this to be a crime against democracy. they want it repealed and the issue will go on and on. what people wanted most was to get their costs down. could there possibly be a more misnamed what and the affordable care act? i think not. mr. obama repeatedly has said during his campaign that health costs for the average family would go down by $2,500 a year by the end of his first term. but costs are rising faster than they have beenof

years. the kaiser family foundation survey found premiums for the average family policy increased by $1,300 last year alone. three times faster than the year before. as many more mandates come from washington, costs will continue to go higher and higher and consume a bigger share of family budgets as well as employer budgets. the $500 billion in new taxes only some of which are in effect will certainly increase the cost of health insurance for their. no one else to pay for these bills but us. whatever pocket they are taking at out of we are going to pay the bills. a number of factors contribute to rising health-care costs but the mandates and the taxes and the regulations in this new health lot will send costs soaring.

the congressional budget office assumes the average family policy will cost $20,000 a year by the time the law is up and running in 2016. and remember that policy is no longer going to be optional. it is mandatory. if the supreme court upholds this provision of the new law. $20,000 a year to purchase a health insurance policy that the government tells you you have today, tend to millions of new people find this policy, the government sells the of policy anyway, the government is requiring insurance company to sell me a policy so why should -- the time i needed for the price, same premium i would have been paying at i been buying and all along. with this individual mandate to. we may actually wind up with a

worse problem of uninsured. as americans follow the incentive. should i spend $695 or 2% of my income as a fine for by $20,000 health-insurance policy. the same will be true with employers as they begin to send their employees to the exchange and eliminate this cost or simply pay the fine. former congressional budget office director douglas holtz-eakin assumes as many as thirty-five million additional people will wind up in the taxpayer subsidized exchanges and the results in system to be dumped from their employer plan into exchanges and we could have another conversation about exchanges but they will likely wind up in coverage that is not going to look different from medicaid today. and what we know is medicaid

pays doctors and hospitals so little, and private physicians. they can't afford to see patients. they can't pay their nurses for their overhead for that. that is the program we are expecting people to go into. the president wants us to think it is just the small stuff. 26-year-olds, free preventive care and this whole tsunami coming at us. if the president is reelected and this law stays in place even if the individual mandate is struck down there are huge consequences for the economy. i believe job creation will continue to stall. we see the new cbs where i live. they put in automatic checkout

facilities. lower wage jobs are going to vanish because employers simply can't afford to pay the huge health-insurance costs or even the fines for lower income lower wage workers replacing them with technology. the very jobs people need to get their foot on the latter, to get into the workforce are the ones that are going to be killed first by obamacare. imagine also employers, tens of millions of americans the siding to violate federal law as a matter of family budget decisions. what does that say about our civil society in america? what will that mean for our country when tens of millions of people and hundreds of thousands or millions of businesses

violate federal law? that will have a corrosive effect for our economy and for our ability to function as a civil society in this country. one final thought. talking with a very wise staff member on the senate side e-mail in back-and-forth. and health and human services. and catholic employers must provide preventive care improve contraception and produce abortion. and part of the health plan. one day you would find -- the president called -- the president of the u.s. council, before the announcement was made. we're giving you a year to

comply and timothy bowlen rightly said after that they are giving us a year to figure out how to violate our most fundamental conscience and principles? it is not going to work. so put them in a very difficult position of saying we are either going to violate federal law, pay the fines or violate our conscience. not optional solutions. that is an example of why is not just the individual mandate that is in question. before the supreme court. the very dna of this law is unconstitutional. it is commandeering of the state, violating the tenth amendment. violating the first amendment as we said with a violation of religious freedom. first amendment guarantee of religious freedom. individual mandates whether or not that is up held as part of

the commerce clause. if it is then what does our constitution say about the ability of free citizens to govern the ourselves leaders will make our own decisions or whether or not the federal government is going to come in and order our lives and confiscate our own personal property and tell us you have to spend $20,000 a year of your family budget even if that is more than you are paying for your mortgage or rent? in order to comply with federal law? that is why this law must not stand. of the court upholds it it will be back at the ballot box in 2012 and the american people are going to have the final say on this all. thank you very much. [applause] >> wonderful. i thank all three if you for excellent remarks and reminding us again two years later the problems we have with this

health care law. i want to underscore another trend we see which is this is what we know today. there are mounds of regulation and information we will still have to wait to see. i think that really underscore is the danger of moving forward with this health-care law because we are not clear as to what the final package will look like. ..

you really only want the 51 votes that the senate in order to you. most of the major sitting provisions that michael particularly talked about. and you can't spend any money than the rest of the blog really is not going to -- is going to come. so the majority in the house and a member they passed a big piece of this reconciliation and 20 times in order to get it through after scott brown was elected in massachusetts and they only had 59 votes in the senate. so a lot of it could be undone by the true reconciliation. you might google key tennessee to look at more detailed description of this. >> any other comments? question in the back. >> president obama talks about the health care law about

denying coverage in this initiative. in your study you said you mentioned -- [inaudible] >> yeah, the problems with their feet their feeding the provision as it will be even worse than the current situation. the fact is that insurance is expensive to insure people who are sick. asserted preexisting condition situation is like being able to drive your car into a tree and then pick up the phone in a veterans day geico now is the time for me to have that auto insurance. you are waiting until you are sick and then becoming insurance. that is about risk for insurers. now, you can prohibit them pass a lot of signatures discriminate against you. okay, but what will they do? will come you have an awful lot of insurance offices around the 64 of a walkout said that it's much harder for sick people to get up there and come in and

sign the paperwork, which they will do. are the easiest thing is if you don't want a lot of cancer patients, for example and your insurance plan, you don't sign up any oncologist in your network about yours. so basically if you have cancer you look around for which insurance policy to join, well you don't sign up for this one because i won't fail to get treated to see an oncologist so have to go to this other one. so which will start seeing as the rush from quality among insurers as they basically try to have a lot of health clubs that they will reimburse for her to sign up healthy people and very few procedures to pay for people who are actually sick or so they would've heart surgeons come oncologist, people who are sick. they change the nature assurance 20 treats healthy people and stops treating sick people. what you want to do is lower the cost of insurance for people young and healthy by moving regulations and making it cheaper for people to sign up

when they're young and healthy and allow them to stay in the plan throughout their lifetime and as they get sicker, the insurance company built the cost in and makes it much more sensible market. >> but then, it starts to have been for regulations for insurance companies include in their networks. >> sure, it constantly changes in the wheel so to speak. you can constantly cover the new regulation, but people always smarter and will find a way around it and will always just cost a lot more and cover a lot less care. >> bush is going to add under the affordable care if they put viability of dollars to help those people who have preexisting conditions if they've been out of work without insurance for six months or more. and richard foster says 5 billion will be gone by 2012. this is between 2011 and 2014. well, they have said the

administration said about 400,000 people would be moving into these to get the insurance and the high-risk pool. only 41,000 people have actually signed up for the insurance in the state's high risk pool, which makes one wonder how many people really are with preexisting conditions. even though so few have signed up, about five states have gone back to the fed saying, the son of money here for us to make high-risk pool work, so they are asking for money from the fed. so it just shows the example that this will cause so much more than the administration in the cbo have ever said. >> and i just say also one of the reason the states are spending more is because when the premiums were sent at the legal level according to how the law was written, few people were buying insurance because it was so expensive. so hhs added a new director disable cut the cost of the insurance of the insurance is less expensive and therefore we are running out of money even

faster. so the government just understand how to make the market work. only markets to how to make markets work. washington does things a director since many you're during my money and it's just not going to work for 16 of our economy. >> there's a question that they are. >> isn't the insurance war -- [inaudible] [inaudible] and just hire a car, say -- [inaudible]

in may 2011, the question is termed universal health care come universal health insurance, which is a course rewarded as even the economist is moved on the day sent only two thirds of the uninsured coverage. so it was not specifically about requiring the insurance purchase and not only got 51 to 44. and another question to ask if we afford to continue. >> go ahead. >> just real quick on the whole idea of universal coverage, i think it is a mistake to focus on the number of people with insurance as opposed to a healthier population. we tend to conflate the idea of health with health care with health insurance.

and the three things are entirely different. with the goal is at the end of the day is a healthier population. one way to do that is to health care come to see doctors and hospitals and so on, but not the only way. one way to pay for seeing doctors and hospitals and so on mr. health insurance, but it's not the only way. in terms of your bang for your buck, the study repeatedly show that it's buying insurance for someone it's not going to be the biggest bang for your buck in terms of help at the downtime. he might be much better off using that to expand access another race at community health clinics or things of that nature or you might be better off spending the money and something has nothing to do with seeing a doctor, but more to do with promoting healthy lifestyles, getting people to eat better or workout more things like that to have a much better impact at the bottom end. so we should not necessarily judge success of a health care plan by whether or not it gets a whole bunch of people with coverage. you know, having a piece of

paper in your hand that says this is health insurance isn't a guarantee to see a doctor. everyone has universal coverage, but she wait to see a doctor. and seeing a doctor is a necessarily going to make you healthier if you didn't let and stop exercising any too much a no follow the doctor's advice is not going to do any good. so the three should not be conflated. >> is just going to say that the administration is 2.5 million kids are in your parents after plain until the age of 26. so this is a huge success. as chris murray said the kaiser foundation show that the average family premium last year was $15,000, up 9%. the previous eras of 3%. of the 2.5 million children up to the age of 26, how many of them had camino come individual plans before recovered and decided it was cheaper to leave that and go join their parents planned? that is something i want to look into because there could be a lot of shift from one type of

insurance to another. >> i think we are fortunate enough to have former congressman john shadegg, even though he is behind the pole here so i can't see them, so i hope that is you. >> as the panel has pointed out, there is extraordinary cost, which was misrepresented. in addition over the last year there's been ample evidence of provisions which are outrageous failures and not on words. yet the congress, specifically the house does not seem to be not much legislation. i have two questions. one is, how can we make obamacare an important and critical issue in the 2012 election because i do think he was a referendum in the 2010 elections. and second, shouldn't the congress, specifically the house be repealing some of the outrageous or outrageously expensive provisions and sending them to the senate so we can continue to remind the

electorate of how bad the policy is and how much damage it would do. >> congressman, what we are due is leading the charge of how we make sure obamacare stays a key issue in 2012. the house will be taking up the repeal of the class thought the lawn care provision that democratic members have called a ponzi scheme of the first-order. last, they are going to be taking it next week. i believe they have the independent aboard, the rationing board and medicare up for debate. they're certainly going to be intention to the individual man's, the clear mandate and focus on killing jobs. so i think they need to continue to focus on his lot and shine a light.

one issue after another so that people do understand it is so much more than a half a dozen things the president will talk about and it really is this monstrously complex for figure of leadership in getting us to unders and being how we can reform health reform and the right way has just been crucially important and i'm glad that your continuing to be affiliated with the heritage foundation to keep your voice in the public domain we need your wisdom. >> i was a part of the problem is let's face it, congress has the attention span of an ant. they figure the first route they would take would be on repeal. they took it in the past and it died in the senate like everything does and they said well, we fulfilled our obligation to bowie said. let's move onto debating some other crucial issue. they may post offices or whatever. and it did not today.

they will finally have -- they were directed to come up with a replacement plan. they will finally have a replacement plan they will announce sometime after the supreme court rules the legislation as a whole. so you know, they don't seem to be in any rush to get out and do this. and i think it is partly because the pressure has been offered the american people. people got cynical. we'll want to repeal it. 53% in the latest polls still want to repeal it. it is about a 15 to 20-point margin in all the polls say they want to repeal. the bill has not gotten any more popular no matter how many times it's been explained to people. but there's so many other things on our mind and people aren't writing, aren't asking for it to be repealed anymore and frankly the congressman got a phone call the night before, they move on. >> and i think it is so very

important that we keep the drumbeat of. off edge, radio shows people got to get the american people reengaged. there engaged in november 2010 of us got to get a backup. the former senator from minnesota just yesterday, who is an advisor to mayor romney said, well, the gop is not going to repeal this. i thought where is this coming from? is not going to help mr. romney's campaign. we've got to keep up pressure for why it is so important. because of mr. palma is reelected in 2012, he will continue to veto an repeal bills like would have been with the senate in january of last year. it is just so very important that the drumbeat because in canada, since 1974 we still have the single-payer system. there are private banks that are working, but by 2014 will be impossible to get rid of the government program. you can never get rid of government pros